There are many national healthcare stressors. An issue that strikes my attention the most is the cost of medications. Drug costs are at a record high, and it seems that no relief is in sight. Due to the excessive cost of some medications, many people cannot afford to purchase their much-needed treatment. Per the Affordability Conundrum, the high cost of medications is not only a burden to the patients, but it also affects their families and society (Sciences et al., 2017). This healthcare stressor holds true for both insured and uninsured individuals.

I currently work at a Mental Health hospital as a Military Psych Nurse. In this position, I often see a recurrence of the same patients at our facility, and one of the main reasons is that they could not afford their psychiatric medications. Millions of patients must choose between purchasing their physical illness medications versus their mental health medications. This results in not only a lapse in treatment, but it could ultimately lead to a patient’s death (Whitehead, 2020). It is disheartening to witness the same patients, whom we work so hard with to get to a functioning level, return to our facility with a week of their discharge. Ongoing adherence to antipsychotics is critical for optimal outcomes in patients with serious mental illnesses (Velligan et al., 2017).

My healthcare work setting has responded to this national stressor giving the leftover psychiatric drugs to our patients upon their discharge. Our patients receive a 30-day supply of medications upon their admission, and upon their discharge, we receive approval from the Physician to send any remaining pills home with them. This implementation has been working at my facility, but I am aware that this is not practiced at surrounding mental health hospitals. This difference can be problematic when an individual has been a patient at more than one hospital and is expecting the same discharge procedure as ours.

References

Sciences, N. A. of, Engineering, & Medicine, and. (2017, November 30). The Affordability Conundrum. Making Medicines Affordable: A National Imperative. https://www.ncbi.nlm.nih.gov/books/NBK493099/.

Velligan, D. I., Sajatovic, M., & Hatch, A. (2017, March 3). Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness. Patient preference and adherence. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344423/.

Whitehead, J. (2020, August 20). When you can’t afford your medication: Rising drug costs imperil mental health treatment. Ledger. https://www.clarionledger.com/story/news/2020/08/20/rising-drug-costs-mental-health-treatment-risk/3349776001/.

Discussion: Review of Current Healthcare Issues

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By Day 6 of Week 1

When I worked at an inpatient psychiatric hospital, we did not have the practice to give the patients a 30-day supply; I do like this idea, though! We gave them a prescription for a two week supply, and they filled it with the promise to see an outpatient provider before they ran out. Unfortunately, having an appointment within two weeks of discharge did not always happen due to the shortage of psychiatric providers in my community.

Hefazi et al. (2020) discuss the high cost of re-admissions contributing to healthcare organizations’ present challenge. The study looked at the high price associated with mistakes on the discharge medication reconciliation and how this contributed to seven-day and 30-day re-admissions. When I went over discharge paperwork with patients, I would often find errors that needed changing before discharge. We also looked at the cost of these medications, and sometimes pharmacies were willing to work with us to get a lower price. I wish that the providers had considered the cost of drugs prior to prescribing them because compliance is essential in this population.

When patients are faced with obstacles, they are less likely to adhere to medication treatment (Albright, 2015). One of these roadblocks is a policy that limits the use of prescribed medications called “fail first” (Albright, 2015). These policies were put in place to reduce costs but caused secondary costs (Albright, 2015).  The restrictions should be evidence-based, but most of them are cost-based (Albright, 2015).

One of the most considerable obstacles that states have implemented is prior authorizations. I see this in our clinic and the time spent on the phone for prior authorizations cuts into treatment time. Sometimes this influences the medication choice for a provider.

We have access to many samples given to us by pharmaceutical representatives; they visit quite often. Sometimes this is the more comfortable choice for prescribers as a trial for a newly diagnosed patient. When the trial is successful, the pharmaceutical representatives help navigate any red tape to make a smooth transition for the medication to make it into the patient’s hands.

We have also tried hiring assistants to help the providers with some of the prior authorizations. Unfortunately, this has been inconsistent and aggravating for the providers because they never know when they can rely on this service.

References

Albright, B. (2015). Medication cost-cutting plans burden physicians and clinicians. Behavioral Healthcare, 35(1), 20-24. https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fdocview%2F1658372446%3Faccountid%3D14872

Hefazi, E., Boggie, D., Huynh, T., & Lee, K. C. (2020). Influence of psychotropic medications on readmission rates of patients receiving a pharmacist discharge medication reconciliation. Journal of Pharmacy Practice. https://doi.org/10.1177/0897190020904466